scuba course application
Date:______
name:
address:
city/state/zip:phone-hm / phone-wk:
Birthdate: / Email: / Occupation:
Available courses:
SCUBA DIVER (OW) / NITROX SCUBA (OW) weekend / DAN O2
PRIVATE / MASTER
ADVANCED SCUBA / DIVEMASTER
MEDIC/FIRST AID/CPR / REFRESHER
DIVE RESCUE / OTHER
Start date/time:
Form of payment: /
How did you here about UA?
cash / $check / # / / Referred by:
check all of the following that apply to you:
Operation or illness / Asthma* / Emphysema*Hospitalized / Tuberculosis / Diabetes*
Serious Illness / Respiratory Problem* / Epilepsy*
Physical Handicap / Pneumothorax* / High Blood Pressure*
Regular Medications / Chest Pain / Breathing Difficulty*
Dizziness or Fainting / Pregnant* / Serious Problem Not Listed
Heart Trouble* / Tranquilizers
Ear Trouble / Bronchitis*
comment:
- Any of the above listed conditions may exclude you or place you at an increased risk of injury from scuba diving. It is your responsibility to inform Underwater Adventures of any and all medical conditions or problems you may have, whether listed above or not. Failure to do so will negate your right to a refund of course fees due to medical disqualification.
I certify that the above information is correct. I understand and agree to all terms and conditions listed on page 2 of this form.
SignatureDate
openwater certification course
policies and procedures
The dive student registered on page 1 of this form understands and agrees to the following:
Course Fees Classroom instruction
Includes: Pool training
SCUBA gear (BC/Reg) needed for pool training
Course Fees Textbook, workbook, log book and dive tables
Do Not Include: Personal diving gear needed at start of pool training –
(mask, fins, snorkel, booties, mouthpiece, weight belt + weights)
SCUBA gear needed for openwater training
Openwater training dive trip – boat charters, air fills, lodging and transportation
Store Policies: Students are guaranteed a proper fit with diving gear
purchased from Underwater Adventures, LLC. unless gear
is damaged. DO NOT mark gear until fit is insured
Certification must be completed within 6 months from the date
of the last scheduled class & pool session, or the student will
have to enroll in another class for an additional cost
Due to special pricing and/or scheduling requirements, the
fees paid for participation in the course are NON-REFUNDABLE
There will be a $25.00 fee charged if the class is rescheduled. Course fees will expire ONE year from the above-indicated date
Scheduling additional pool time after the course is completed will incur added costs
The student must provide his/her own personal dive gear (mask, fins, snorkel,
booties, mouthpiece, weight belt and weights) for the course
The student must provide class materials (textbook, workbook, folder, logbook and plastic dive tables) for the course
The student must participate in Openwater training in order to complete and
receive certification (note additional weights may be needed for Check out)
Students may be disqualified from diving due to medical reasons. Course fee is
nonrefundable unless otherwise instructed at sign-up
Class must be scheduled and taken within a year from the initial sign up date or no money will be refunded
This is to certify that / has registered inڤ m/w ڤ t/th / SCUBA DIVER offered by Underwater Adventures
Course begins on / , / 20 / At 6:00 PM at 5555 Government Street in
Baton Rouge, La. Above registered has paid $ / Course fee on the above referenced class.
Authorized SignatureDate
questions and answers
about our courses
What is theThe course is offered in two ways
length of the course?1. A 4-week course, meeting 2 nights per week. The class meets from 6:00 to 9:00 pm Monday/Wednesday or Tuesday/Thursday nights.
2. A weekend course begins on Tuesday night (at the store) and is completed Sunday afternoon. The class meets Tuesday and Friday from 6:00 to 9:00 pm and on Saturday and Sunday from 8:00 am to 6:00 pm.
Final written exam is taken Sunday afternoon.
Due to the fast pace of the weekend class, the following is REQUIRED prior to Tuesday night meeting: 1. O/W textbook must be purchased, and read; and workbook, or modules, must be handed in to your instructor by the last class session 2. Two (2) passport, or photo booth, style photos for documentation must be turned in by the second class session (available at store for a fee)
Do I have to be aNo, but you do have to be comfortable in the water. With
strong swimmer?today’s technology, scuba diving is easy to learn. Minimum swimming requirements expected: 250 yard swim, 10 minute tread, 50 foot underwater swim.
Where will theThe SCUBA DIVER course will be held at the A.C. Lewis
courses be held?YMCA (North Foster Drive), Pennington YMCA (Old Hammond Hwy, near O’Neal Lane), Manship YMCA (Perkins Rd, near Bluebonnet), Ketcham Fitness Center or one of the LSU aquatic facilities. The weekend course is held at the shop for class sessions and, typically, the A.C. Lewis YMCA or Ketcham Fitness Center for pool sessions.
What personalYou must have a mask, snorkel, fins, booties, weight belt + weights (10%
Equipment will I need?of body weight), O/W packet including textbook, workbook, dive tables, and log book.
When and where canIn your first class, your instructor will explain all of the gear options and
I purchase equipment?will be able to assist you in picking the correct gear for your needs.
(Weekend participants may want to schedule time prior to the first night of class).
At Underwater Adventures we take pride in what we do, and this is reflected in our courteous, knowledgeable staff, headed by Mark Smith. We know that you are counting on us for a safe and enjoyable experience, whether it is a family dive vacation with us to Florida, or a spear fishing adventure in the Gulf. That’s why we stay on the cutting edge of diving technology.
Specialty and Continuing Education Courses
ADVANCE SCUBA*RESCUE DIVER*MASTER DIVER*
U/W PHOTOGRAPHYMEDIC/FIRST AID*DIVEMASTER+
SPEAR FISHING DAN O2CPR CERTIFIED*
EQUIPMENT SPECIALISTNITROX/TRIMIXINSTRUCTOR+
* PRE-REQUISITE TO DIVEMASTER+ LEADERSHIP LEVELS